Does the patient-dentist relationship moderate the association between adult dental anxiety and dental attendance? A secondary analysis of the 2009 Adult Dental Health Survey
Objectives: The main objective was to test if the patient- dentist relationship acts as a moderator role in the association between dental anxiety and dental attendance in adults aged 16 years and above in England, Wales and Northern Ireland, using the 2009 ADHS.
Methods: The 2009 ADHS was cross- sectional in design and used random two-stage cluster sampling via interviews of 11,380 adults aged 16 years and above. The outcome, dental attendance, was measured using two variables, ‘Reason for attending’ and ‘Frequency of attending’. The exposure, dental anxiety, was measured using the Modified Dental Anxiety Scale (MDAS). The potential effect modifier, patient-dentist relationship, was measured using a series of yes/no statements for individuals to rate their relationship with the dentist at their last visit. Survey weights were applied to the dataset. A complete case-analysis was conducted on a final sample of 10,470. Binary logistic regression was performed, and four models were run for each outcome variable separately.
Results: Individuals reporting a suboptimal patient-dentist relationship were around twice as likely to be problem-oriented visitors (CI= 1.75, 2.31, p<0.05) and irregular attenders (CI= 1.66, 2.26, p<0.05) compared to those reporting an optimal one. None of the interaction terms were statistically significant. However, there was attenuation in the association between dental anxiety and dental attendance, after adjusting for patient-dentist relationship.
Conclusions: The patient-dentist relationship did not moderate the association between dental anxiety and dental attendance. There was, however, a possibility of its role as a mediator or a confounder, due to the attenuation observed in the association after its addition to the model. An effort should be made to alleviate dental anxiety levels by developing positive relationships with all patients so that regular dental attendance is maintained and oral health is not compromised.